Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA.
Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA.
Am J Geriatr Psychiatry. 2022 Mar;30(3):392-403. doi: 10.1016/j.jagp.2021.07.008. Epub 2021 Jul 30.
Geriatric depression is difficult to treat and frequently accompanied by treatment resistance, suicidal ideations and polypharmacy. New adjunctive mind-body treatment strategies can improve clinical outcomes in geriatric depression and reduce risk for side-effects of pharmacological treatments.
We conducted a 3-month randomized controlled trial to assess the efficacy and tolerability of combining Tai Chi Chih (TCC) or Health Education and Wellness training (HEW) with the stable standard antidepressant treatment on mood and cognitive functioning in depressed older adults (NCT02460666). Primary outcome was change in depression as assessed by the Hamilton Rating Scale for Depression (HAM-D) post-treatment. Remission was defined as HAM-D ≤ 6; naturalistic follow-up continued for 6 months. We also assessed psychological resilience, health-related quality of life and cognition.
Of the 178 randomized participants, 125 completed the 3-month assessment and 117 completed the 6-month assessment. Dropout and tolerability did not differ between groups. Remission rate within TCC was 35.5% and 33.3%, compared to 27.0% and 45.8% in HEW, at 3 and 6 months respectively (χ(1) = 1.0, p = 0.3; χ(1) = 1.9, p =0.2). Both groups improved significantly on the HAM-D at 3 and 6 months. TCC demonstrated a greater improvement in general health compared to HEW.
Both TCC and HEW combined with a standard antidepressant treatment improved symptoms of depression in older adults. While TCC was superior to HEW in improving general health, we did not find group differences in improvement in mood and cognition.
老年抑郁症难以治疗，且常伴有治疗抵抗、自杀意念和多种药物治疗。新的辅助身心治疗策略可以改善老年抑郁症的临床结局，降低药物治疗副作用的风险。
我们进行了一项为期 3 个月的随机对照试验，以评估太极拳气功（TCC）或健康教育和健康促进培训（HEW）与稳定标准抗抑郁治疗联合治疗对老年抑郁症患者情绪和认知功能的疗效和耐受性（NCT02460666）。主要结局是治疗后汉密尔顿抑郁量表（HAM-D）评估的抑郁变化。缓解定义为 HAM-D≤6；自然随访持续 6 个月。我们还评估了心理弹性、健康相关生活质量和认知功能。
在 178 名随机参与者中，有 125 名完成了 3 个月的评估，有 117 名完成了 6 个月的评估。TCC 组和 HEW 组的脱落率和耐受性差异无统计学意义。TCC 组的缓解率在 3 个月和 6 个月时分别为 35.5%和 33.3%，而 HEW 组分别为 27.0%和 45.8%（χ²（1）=1.0，p=0.3；χ²（1）=1.9，p=0.2）。两组患者在 HAM-D 评分上均在 3 个月和 6 个月时显著改善。TCC 在一般健康方面的改善明显优于 HEW。
太极拳气功和健康教育和健康促进培训与标准抗抑郁治疗联合均能改善老年患者的抑郁症状。虽然 TCC 在改善一般健康方面优于 HEW，但我们没有发现两组在情绪和认知改善方面的差异。
